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2015 ACEP POLL AFFORDABLE CARE ACT
RESEARCH RESULTS
Prepared For:
American College of Emergency
Physicians
March 2015
625 North Washington Street, Suite 450 Alexandria, VA 22314 800.644.6646 toll free
703.739.1000 telephone 703.549.6057 fax
www.MarketingGeneral.com
© 2015 Marketing General Incorporated
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 1
TABLE OF CONTENTS
Project Background ........................................................................................................................2
Research Methodology ...................................................................................................................2
Sample Characteristics ...................................................................................................................3
Findings .........................................................................................................................................8
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 2
ACEP conducted a short poll with its member physicians to understand changes in emergency
department patient volume and care since January 1, 2014, when the requirement to have
health care took effect in the Affordable Care Act (ACA).
Marketing General Incorporated (MGI) sent invitations to participate in the poll on March 16,
2015, to a list of 25,768 current ACEP members.
Of the 25,768 email invitations sent, 1,341 emails bounced or failed to send, resulting in a net
total of 24,427 invitations sent. To boost response rates, MGI sent reminder emails to non-
responders and non-completers on March 18 and March 20.
The poll officially closed on March 23 at 12 noon. A total of 2,099 polls were completed,
providing a response rate of approximately 9%* and a margin of error of 2.1%. The margin of
error, or standard error, is a statistical term used to measure the random fluctuations inherent
in samples—the smaller the standard of error, the more accurate the measurement of the
population or universe.
This study’s significance level of .05 carries with it a 95 percent confidence interval. The
confidence interval is established as the likelihood that the same results would be achieved in a
similar study, meaning that if we were to conduct this study 100 times, then the same results
plus or minus the margin of error (2.1%) would occur 95 out of 100 times.
* A response rate of 9% is above average based on previous research MGI has conducted in the past. Typically, we see an 8% response rate for polls.
Project Background
Research Methodology
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 3
Number of Responses per State
STATE COUNT PERCENT STATE COUNT PERCENT
Alabama 17 1% Montana 9 0%
Alaska 10 0% Nebraska 13 1%
Arizona 41 2% Nevada 16 1%
Arkansas 10 0% New Hampshire 19 1%
California 229 11% New Jersey 49 2%
Colorado 55 3% New Mexico 12 1%
Connecticut 37 2% New York 138 7%
Delaware 13 1% North Carolina 54 3%
District of Columbia 14 1% North Dakota 6 0%
Florida 82 4% Ohio 99 5%
Georgia 59 3% Oklahoma 17 1%
Hawaii 7 0% Oregon 37 2%
Idaho 10 0% Pennsylvania 103 5%
Illinois 80 4% Rhode Island 13 1%
Indiana 51 2% South Carolina 26 1%
Iowa 19 1% South Dakota 6 0%
Kansas 11 1% Tennessee 27 1%
Kentucky 30 1% Texas 147 7%
Louisiana 14 1% Utah 17 1%
Maine 10 0% Vermont 7 0%
Maryland 42 2% Virginia 60 3%
Massachusetts 61 3% Washington 64 3%
Michigan 103 5% West Virginia 10 0%
Minnesota 50 2% Wisconsin 36 2%
Mississippi 15 1% Wyoming 3 0%
Missouri 35 2%
The top 10 participating states include:
1. California 229—11% 2. Texas 147—7% 3. New York 138—7% 4. Michigan 103—5% 5. Pennsylvania 103—5%
6. Ohio 99—5% 7. Florida 82—4% 8. Illinois 80—4% 9. Washington 64—3% 10. Massachusetts 61—3%
Sample Characteristics
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 6
What is the emergency department patient volume where you work the majority of your
time?
Currently, 24% of member physicians practice in an emergency department with patient volume
between 50,001-75,000, and 32% practice in emergency departments with patient volumes above
75,000.
2%
6%
9%
13%
12%
24%
19%
13%
0%
0%
1%
0% 5% 10% 15% 20% 25% 30%
Up to 10,000
10,001-20,000
20,001-30,000
30,001-40,000
40,001-50,000
50,001-75,000
75,001-100,000
100,001-200,000
200,001-300,000
More than 300,000
Not sure n=2,099
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 7
As an emergency physician, do you work directly for your hospital or for a private group
contracting with your hospital?
Most respondents (60%) work for an emergency medicine group.
31%
60%
8%
Directly for my hospital
An emergency medicine group
Neither
n=2,099
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 8
Since January 1, 2014, when the requirement to have health coverage took effect in the
Affordable Care Act, the volume of emergency patients in my emergency department has:
Since the implementation of the ACA, the majority of member physicians have noticed an increase in the
volume of emergency patients. Specifically, 47% of emergency physicians indicate slight increases in the
number of patients, while 28% of respondents report significant increases in the number of emergency
patients.
28%
47%
17%
5%
0%
3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Increasedgreatly
Increasedslightly
Remained thesame
Decreasedslightly
Decreasedgreatly
Not sure
n=2,098
Findings
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 9
Since January 1, 2014, the volume of Medicaid emergency patients in my emergency
department has:
Similar to their responses for the change in volume of emergency patients, over half of emergency
physicians indicate that the volume of Medicaid patients increased greatly (24%) or slightly (32%).
24%
32%
19%
1% 0%
24%
0%
5%
10%
15%
20%
25%
30%
35%
Increasedgreatly
Increasedslightly
Remained thesame
Decreasedslightly
Decreasedgreatly
Not sure
n=2,098
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 10
If visits were to increase, is your emergency department adequately prepared for potentially
significant increases in patient volume?
70% of member physicians believe their emergency department is not adequately prepared for
potentially substantial increases in patient volume.
22%
70%
8%
Yes
No
Not sure
n=2,084
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 11
Since January 1, 2014, the acuity of emergency patients’ injuries/illness in my emergency
department has:
Approximately 4 in 10 respondents report the acuity of emergency patients’ injuries or illnesses has
remained the same since January 1, 2014. 44% of current members have noticed significant (14%) or
slight (30%) increases in the acuity of emergency patients’ injuries or illnesses in their emergency
department.
14%
30%
42%
10%
2% 3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Significantlyincreased
Slightlyincreased
Remained thesame
Slightlydecreased
Significantlydecreased
Not sure
n=2,098
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 12
How have volumes of patients with less severe illness at your emergency department
changed because of urgent care centers?
Despite urgent care centers, 43% of member physicians report the volume of patients with less severe
illness at their emergency department remains the same.
7%
16%
43%
17%
5%
11%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Significantlyincreased
Slightlyincreased
Remained thesame
Slightlydecreased
Significantlydecreased
Not sure
n=2,094
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 13
How have volumes of patients with less severe illness at your emergency department
changed because of retail clinics?
For the majority of current members (49%), retail clinics have not changed the volume of patients with
less severe illness at their emergency department. About one-quarter (26%) of respondents are unsure
of the impact retail clinics have had on patient volume.
4% 7%
49%
11%
3%
26%
0%
10%
20%
30%
40%
50%
60%
Significantlyincreased
Slightlyincreased
Remained thesame
Slightlydecreased
Significantlydecreased
Not sure
n=2,091
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 14
How have volumes of patients with less severe illness at your emergency department
changed because of telephone triage lines?
44% of respondents report that they are unsure how the volume of patients with less severe illness has
changed. However, 39% of respondents indicate that the volume of patients with less severe illness
remains the same.
4%
11%
39%
2% 0%
44%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Significantlyincreased
Slightlyincreased
Remained thesame
Slightlydecreased
Significantlydecreased
Not sure
n=2,086
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 15
How have volumes of patients with less severe illness at your emergency department
changed because of more primary care options?
Notwithstanding the availability of more primary care options, the volume of patients with less severe
illness remains relatively unchanged for 49% of respondents. 23% of current members are unsure about
the impact of more primary care options on the number of patients.
6%
15%
49%
6%
1%
23%
0%
10%
20%
30%
40%
50%
60%
Significantlyincreased
Slightlyincreased
Remained thesame
Slightlydecreased
Significantlydecreased
Not sure
n=2,093
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 16
Have you considered leaving the practice of medicine because of reductions in
reimbursement for emergency care?
In spite of the reductions in reimbursement for emergency care, 66% of member physicians indicate
that they have not considered leaving the practice of medicine, although 34% have considered leaving
the profession.
34%
66%
Yes
No
n=2,097
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 17
Are efforts being made in your community or state to reduce the number of emergency
patient visits?
When asked if efforts are being made in their community or state to reduce the number of emergency
patient visits, 41% of respondents report that no efforts are being made. 38% of respondents report that
efforts are being made to decrease the number of emergency patient visits.
38%
41%
21%
Yes
No
Not sure
n=2,096
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 18
Is your community or state actively engaged in diverting Medicaid patients from the
emergency department?
Almost 6 in 10 current members’ communities or states are not actively involved in diverting Medicaid
patients from the emergency department.
16%
58%
26%
Yes
No
Not sure
n=2,096
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 19
Do you have any concerns about efforts being made to reduce emergency visits? Check all
that apply.
83% of member physicians have concerns about efforts being made to reduce emergency visits. Most
respondents are concerned that patients will delay medical care or go to a less skilled site (44%). Other
concerns about current efforts include their minimal impact on decreasing the volume of patients (44%)
or lessening health care spending (41%).
44%
44%
41%
38%
32%
17%
9%
0% 10% 20% 30% 40% 50%
Yes, patients with medical emergencies may go toa less skilled site for medical care, delaying critical
care
Yes, the efforts do not reduce the volume ofpatients
Yes, the efforts do not significantly reduce healthcare spending
Yes, patients may not get the care they need
Yes, the efforts violate the federal prudentlayperson standard (NOTE: the standard ensures
that health plans pay for coverage based onpresenting symptoms, not the final diagnosis)
No concerns
Other
n=2,014
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 20
If federal subsidies for health insurance coverage were to be eliminated in your state, how do
you think that would affect emergency department visits? (NOTE: the Supreme Court heard
arguments in March 2015 and expects to announce its ruling in June — King v. Burwell — on
whether low-income patients enrolled in a federal exchange are eligible for subsidies)
When asked how elimination of federal subsidies would affect emergency departments, 73% of
respondents indicate that emergency visits will increase (42%) or remain the same (31%). Only 12% of
current members report either that emergency visits will decrease (10%) or their emergency
department will be at risk of closing (2%) if the government eliminated federal subsidies for health
insurance.
42%
31%
10%
2%
16%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Emergency visitswill increase
Emergency visitswill stay the same
Emergency visitswill decrease
My emergencydepartment will be
at risk of closing
Not sure
n=2,096
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 21
If federal subsidies for health insurance coverage were to be eliminated in your state, how do
you think that would affect your reimbursement for emergency care?
The majority of current members (65%) indicate that reimbursement for emergency care will decrease if
the federal government were to eliminate federal subsidies for health insurance coverage in their state.
2%
16%
65%
17% Reimbursement foremergency care will increase
Reimbursement foremergency care will remainthe same
Reimbursement foremergency care will decrease
Not sure
n=2,096
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 22
Since January 1, 2014, have you or your group stopped accepting payments from a health
insurance plan(s) (taking you or your group out-of-network)?
65% of respondents indicate that they have not stopped accepting payments from a health insurance
plan or plans that are taking them out-of-network. Only 5% of current members have stopped accepting
payment from a health insurance plan(s) that are taking them out-of-network.
5%
65%
6%
24%
Yes
No
Considered/considering it
Not sure
n=2,096
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 23
Since January 1, 2014, how have demands on your time changed to coordinate patient care
following visits to the emergency department?
64% of current members say that the time spent organizing patient care following visits to the
emergency department has increased since January 1, 2014.
64%
31%
1% 4%
Demands are increasing
Demands have not changed
Demands are decreasing
Not sure
n=2,096
2015 ACEP ACA Poll Results
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 24
What is the top reason demands for care coordination are increasing?
47% of member physicians believe demands for care coordination are increasing due to increased
difficulty in finding/arranging timely follow-up with primary care physicians and/or specialists.
47%
28%
13%
4%
1%
7%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Increased difficulty at finding/arranging timelyfollow-up with primary care physicians and/or
specialists
Increased resistance to admit/readmit patients
Increased complexity of patient illness
Increased patient acuity
Not sure
Othern=1,344
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